IFEBP > ACA University > Health Plan Design > Wellness Programs Wellness Programs The Affordable Care Act (ACA) included several provisions to promote wellness and prevention of chronic diseases. One of these provisions allows health plan sponsors to offer stronger wellness program incentives. Articles Limbo No More? EEOC May Soon Publish New Wellness Program Rules, Fisher Phillips, 5/30/2019 Tobacco Differential Compliance Just Got Trickier, Frenkel Benefits, 5/28/2019 Wellness Programs Continue to Face Compliance Challenges , Jackson Lewis, 2/7/2019 2019 Planning for Health and Welfare Benefit Plan Operations, Buck Global, LLC, 12/13/2018 EEOC Issues Final Rules on Wellness Programs, Littler, 5/20/2016 Checklists Wellness Compliance Checklist for Fully-Insured and Self-Insured Plans, One Digital Health and Benefits, 7/9/2019 FAQs Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions, Congressional Research Service, 5/5/2020 How do tobacco surcharges affect the calculation of whether coverage is affordable?, International Foundation, 6/25/2018 How many times per year does a plan have to allow employees the opportunity to participate in a smoking cessation program to avoid a tobacco premium surcharge?, International Foundation, 12/16/2016 Regarding the wellness incentive of up to 50% offered for tobacco cessation, 1) does the employer have to pay for the tobacco cessation class that must be offered? 2) Does the employee have to actually quit smoking, or just be enrolled in the class?, International Foundation, 5/26/2015 Can the health plan surcharge for smokers also apply to smokeless tobacco users?, International Foundation, 11/15/2013 Government Resources Federal Requirements on Private Health Insurance Plans, Congressional Research Service, 8/28/2018 Final Rule on Employer Wellness Programs and Title I of the Americans with Disabilities Act (ADA), EEOC, 5/17/2016 Fact sheet Final Rule on Employer-Sponsored Wellness Programs and Title II of the Genetic Information Nondiscrimination Act (GINA), EEOC, 5/17/2016 Fact sheet Questions and Answers: Final Rule on Employer Wellness Programs and Title I of the Americans with Disabilities Act, EEOC, 5/17/2016 Questions and Answers: Final Rule on Employer Wellness Programs and the Genetic Information Nondiscrimination Act, EEOC, 5/17/2016 Questions and Answers: Sample Notice for Employees Regarding Employer Wellness Programs, EEOC, 5/17/2016 Wellness programs often gather health information through voluntary health risk assessments (HRAs) or voluntary biometric screenings that include medical examinations (such as tests to detect high blood pressure, high cholesterol, or diabetes). The EEOC published Q&As about the notice requirement and use of the sample notice. Genetic Information Nondiscrimination Act, EEOC, 5/17/2016 FInal rule clarifies that an employer may offer a limited incentive to an employee whose spouse receives health or genetic services offered by the employee - including as part of a wellness program - and provides information about his or her current or past health status, usually as part of a health risk assessment. The value of the maximum incentive attributable to a spouse's participation may not exceed 30 percent of the total cost of self-only coverage, the same incentive allowed for the employee. No incentives are allowed in exchange for the current or past health status information of employees' children or in exchange for specified genetic information (such as family medical history or the results of genetic tests) of an employee, an employee's spouse, and an employee's children. Regulations Under the Americans with Disabilities Act, EEOC, 5/17/2016 Final rule on the extent to which employers may offer incentives to employees to participate in wellness programs that ask them to answer disability-related questions or undergo medical examinations. Wellness programs that are part of a group health plan and that ask questions about employees' health or include medical examinations may offer incentives of up to 30 percent of the total cost of self-only coverage. Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit, IRS, 12/18/2015 Final rule on whether wellness incentives, flex credits and HRA contributions are included when calculating minimum value and affordability Genetic Information Nondiscrimination Act of 2008, EEOC, 10/30/2015 Proposed rule FAQs About ACA Implementation Part XXIX, EBSA, 10/1/2015 Preventive services (lactation counseling, weight management, colonoscopy, BRCA testing), non-financial wellness incentives, and mental health parity disclosure and medical necessity criteria Amendments to Regulations Under the Americans With Disabilities Act, EEOC, 4/20/2015 Proposed rule FAQs About ACA Implementation Part XXV, EBSA, 4/16/2015 Health-contingent wellness program design Minimum Essential Coverage and Other Rules Regarding the Shared Responsibility Payment for Indivduals, IRS, 11/26/2014 Final rule on how wellness program incentives, HRA contributions and Section 125 cafeteria plan contributions are treated in determining whether an individual's employer-sponsored coverage is affordable FAQs About ACA Implementation Part XVIII, EBSA, 1/9/2014 Preventive services (breast cancer), expatriate plans, wellness program reasonable alternatives, tobacco surcharges, fixed indemnity insurance, and the effect of ACA on the Mental Health Parity and Addiction Equity Act of 2008. Self-only annual limits on cost sharing apply to each individual, regardless of whether the individual is enrolled in self-only coverage or other than self-only Incentives for Nondiscriminatory Wellness Programs in Group Health Plans, HHS, 6/3/2013 Final rule on participatory wellness programs, which generally are available regardless of an individual's health status and standards for nondiscriminatory health-contingent wellness programs, which reward individuals who meet a specific standard related to their health. The final rules increase the maximum permissible reward under a health-contingent wellness program from 20% to 30% of the cost of health coverage and further increase the maximum reward to as much as 50% for programs designed to prevent or reduce tobacco use. Incentives for Nondiscriminatory Wellness Programs in Group Health Plans, IRS, EBSA, HHS, CMS, 11/26/2012 Proposed rules Slideshows The Affordable Care Act … It’s Still Here!, American Bar, 4/2/2019